Hi All,

This case report came out recently. I found it after Zoology prompted me to check out any studies examining migraine treatment with a benzo.

Many patients with migraine are poorly responsive to conventional preventive therapies. Comorbid anxiety and depression may contribute to headache refractoriness, but studies of headache preventives have not typically addressed the patient with psychiatric comorbidity. The author has used clonazepam empirically to treat a subgroup of headache patients with associated anxiety, who were poorly responsive to conventional preventives. The use of a benzodiazepine as a headache preventive raises concerns regarding tolerance and addiction. The author presents 3 cases that illustrate different outcomes associated with this therapy, and suggests guidelines for its use.

— Begin quote from ____

• Clonazepam is a long-acting, high-potency benzodiazepine that has been approved by the FDA for the treatment of seizure disorders. It is used more commonly in a variety of psychiatric disorders (especially panic disorder and other anxiety disorders), as well as other neurologic disorders (Tourette’s syndrome, movement disorders), and chronic pain syndromes, especially neuropathic pain.

• Clinicians who treat patients with migraine and associated psychiatric comorbidity have little guidance as to whether standard migraine preventives are the best choice of therapy. Some antiepileptic drugs used for migraine prophylaxis have psychotropic properties, which might contribute to their efficacy as migraine preventives.

• The author has found clonazepam to be clinically useful in patients with primary headache disorders, especially in the presence of clinical/subclinical anxiety.

• Clonazepam is effective for the treatment of panic attacks. Both generalised anxiety disorder and panic disorder are often comorbid with migraine, and clinically appear to contribute to the expression of migraine attacks.

• Clonazepam is also commonly used for the treat- ment of vertigo, although there are no double-blind trials to support its use. Vertigo is commonly comorbid with migraine, and the symptom is particularly difficult to treat.

— End quote

The author suggests the following guideline: while awaiting adequate scientific study, clonazepam may be considered for the patient with headache refractory to standard migraine preventive therapies, after appropriate psychiatric evaluation to determine the presence of depression, anxiety, and any history of chemical dependency. If the patient is being followed by a psychiatrist, the proposed treatment should be discussed with the psychiatrist. Patients who appear more likely to benefit appear to have clinical or sub-clinical anxiety, insomnia, or somatoform symptoms. Small quantities of medication should be initially prescribed, and the patient monitored closely for any sign of dose escalation or adverse effect. Patients should be informed of the potentially addicting nature of the treatment.

Check out the case studies.

Given my excellent response to valium and shocking response to all other migraine meds it’s time to try this stuff.

Note that 0.5 mg of Clonazepam (Klonopin) is equivalent to 10 mg of diazepam (Valium).

Scott 8)

Hey Scott,
Yepper…it works for me. I believe it has a half life about 22 hours and I believe Valium has a super long half life (I’ve read up to 8 days?? But both seem to be very helpful to many of us on this board.
Glad to see something in writing about it…

That’s really interesting, Scott. Especially given the anxious/activated/agitated reactions that many people have to SSRI’s and even topamax/anti-seizure meds. Let us know how it goes if you try Klonopin. I know people on tiny amounts for sleep or anxiety and they are still using the same amount they used almost 3 years ago. That’s definitely not tolerance or habituation in response to the hysteria drumbeat that is heard about benzos, and in particular, clonazepam. It is a very potent med so thankfully the dosing can be much lower.

This Clonazepam seems like good gear. How does it compare with Valium though - pluses/minuses or just different?

Hi Scott,
thanks for finding this article. Clonazepam has done wonders for me and has allowed me to function. - Lisa

I think you will find the effect to be about the same as Valium, but yes, it’s the only thing in the year+ that I’ve had this that helps.

I may have to try it again.

My allergies are flaring up so i feel absolutely awful today - two hours of sleep doesn’t help. I"m taking valium right now feels like my head is gonna burst!


hey scott!

i’ve been on clonazepam for a couple years now for meniere’s. i can’t speak to its efficacy with migraines but i can tell you about my experiences as far as possible addictions, etc. i started with 0.25mg twice a day to try to keep my balance issues under control. that worked for awhile but eventually my doctor had to up me to 0.5mg 3x/day. i stayed at that dose for maybe a year?? last spring, i started to try to wean off of it in an effort to try to “retrain” my brain and let my good ear take over. as you know this class of meds dampens the balance nerves and can slow rehabilitation. so i started by cutting one dose down to 0.25 and went with that for a couple weeks. i had no problems. then i cut one more dose to 0.25 and no problems. that’s as far as i’ve gotten at this point because with all the crazy gent injections, my doctor didn’t want me cut anymore.

however, i did also want to share this. please remember, i take it for meniere’s, not mav. he explained the difference between valium and clonazepam as this. he said valium gets in your system quickly, builds to a peak quickly and then also leaves its therapeutic dose quickly. whereas clonazepam takes awhile to get into your system, takes awhile to reach its peak but it stays at peak for longer than valium and is slower to lose its effectiveness. i was instructed that on my bad days to take the clonazepam as directed but in the “valleys” where it would be wearing off but it wasn’t time for the next dose, it would be okay to take a small dose of valium if needed (like 2mg or so).

i would think that since valium works so well for you that clonazepam could really help. i hope it does!

Hi Nicki,

Thanks for the info from your GP. Hadn’t heard that before about the intended use in terms of valium being more short term versus longer term clonazepam. Also good to hear you’ve been able to reduce C without any perceivable fall out. I seem to get a good result on 2.5 mg of valium so think I won’t need much C to do the job. It’s strange that lorazepam did not work out well for me. I became much dizzier on it and unwell. Hope that’s not the case with C.

Scott :slight_smile:

I had a chat to a GP today at the university about C. I had to get a Paxil script filled and told him I had been using Valium here and there so wondered if a daily low dose of C was useful as a treatment considering I freakin love Valium. He said he couldn’t make the call and to see an ENT. :lol: Yeah right. The only ENT I’d trust is Steve Rauch and that’s where it ends. I might see Halmagyi again and get his support (when I mentioned Halmagyi to this GP today he responded with, “isn’t he dead?” I said WTF? LOL. He’s alive and well thank goodness).

So to my great surprise the GP wrote me a script for another 50 tabs of valium without me even asking! What luck. Every time I get a box of the stuff I feel like I’ve just won the lottery. :lol:



Weird this GP was happy to give you the Valium but not the Clonazepam… It’s funny - some docs (and lay folks too) are SO paranoid about Valium and others get that it’s a great drug when used properly. I’ve been using it sparingly and responsibly for several years now. I’ve never had problems developing tolerance or any kind of withdrawl.

Halmagyi dead?? Thank God he’s not. I think I mentioned in another post that my GP said the other day how lucky I am (and in fact all of Sydney is) to have him - he’s one of the best in the world. I hope he lives forever!

What this says to me is that doctors, despite their lab coats and wall decor of achievements, can be just regular ol’ dumb asses like the rest of the population!! :smiley:
It makes the ones who take the time to listen, and continually learn, really stand out in the crowd. If they think they know it all as of their graduation date, then they are of little use
for these ongoing diseases where we need new, fresh minds to look outside he box…
I have a doctor who “HATES” benzos, her quote…and I have 2 psychiatrists who have no trouble prescribing them to me, and actually chuckle at my hesitance to get addicted…they say it’s not
gonna happen with my personality and reasons for taking it. I truly believe we have to educate ourselves, and this site is a wonderful continuing education for me…I have apprecation and compassion for
everyone on here…

I was recently diagnosed with mav and the dr perscribed me klonopin i and am am alittle scared of medacine and i am in a real bad week and was wondering if anyone has taken it and how does it make you feel and how much do i take to just get rid of this horrible rocking this has been along road to get a diag and it seems to be getting worse any help would be greatly appriciated :smiley:

Thanks , John

Hi John,
The klonopin is a life saver for many, including myself. I take very small doses. I don’t know what amount your doctor prescribed, but I take 1/4 of my pill and it is a .5mg tablet. My doctors say I can take .5mg am and pm to get things under control, but I find it makes me tired, and doesn’t really change the dizziness the more I take. Small amounts work for me.
Klonopin in and of itself, isn’t usually a first line treatment for MAV or Migraine, but is used frequently for anxiety. Most doctors are only comfortable prescribing benzos for short amounts of time, due to them being abused. For those on this site, we aren’t intersted in getting high or using them for a good time, we just want to be functional. I think with that mentality, and being aware of dependency potential, we shouldn’t have those problems.
Good luck.

Just want to add from my experience:

I’ve noticed a big difference between the genetics and the branded form of this. Rivotril in UK is branded and works wonders for me. I’ve used it since 2000 - used to take .5mg when needed. Now .25mg or even .125mg is enough. I try not to take it for more than 4 days running. Downside is it sometimes makes my stomach a bit queasy, but not always. Also I find it stops the dizzies but not the headaches. I’d recommend all MAVers try it just to see.

DizzyIzzy x

Ha - I meant generics not genetics. Stupid auto-correct. :slight_smile:

Hi All.
years ago, I was against all meds, funny how I’ve changed my way of thinking.
An email buddy from another dizzy site, an R/nurse, was told by Dr H, that if she was to stay low on cKlonopin, under 5mg preferably 2mg a day, that she shouldnt have any problems with drawing from it.
She did decided to come off it, (for other reasons) a few years ago, she took it slowly, and didnt have a problem with withdrawal.

I take 5mg of valium beofre bed “every night” now, on top of my other meds.

Good luck with it
I LOVE MY VALIUM!!! :smiley: it’s a life saver…

Hi Jenny,
I am in total agreement with you. I used to avoid using meds but I guess I have adapted to the realities of the MAV situation and come to the realization that meds allow one to be functional (along with lifestyle change). Low dose Clonazepam has certainly added to the quality of my life - Lisa

better living through chemistry - I’m a fan :lol:

To: DizzyLizzy

How were you able to overcome dependency on Rivotril? I know it is addictive. My psychiatrist wants me to taper my medication . Last year it was a rollercoaster ride for me to accomplish that. What compounded the problem is I was diagnosed with Vestibular Migraine which sets of a challenging path for me because that alone creates dizziness . I tried taking Sibelium a calcium channel blocker but it doesnt work well for me (it 5 days under that medication to early to tell?) Aside from your migraines do you have anxiety and depression? I take my rivotril primarily for that. But my how debilitating vestibular migraine is I need rivotril back so I can remain calm. LEssens the severity of the triggers and dizziness. Does anybody agree with me on Rivotril’s effectiveness?

But in the end I do want to taper the meds but I dont know how I could knowing that the dizziness is just waiting to bounce back in. I used to have migraines often but it became this vertigo like symptoms.